Anxiety Disorders and Phobias: A Cognitive Perspective

What Works for Whom? A Critical Review of Psychotherapy Research

Response rates for CBT for anxiety disorders: Need for standardized criteria

The Sheehan Disability Scale (SDS) is a patient-rated, discretized analog measure of functional disability in work, social, and family life. Its increasing use in clinical trials in psychiatry suggests a need to assess its responsiveness and interpretability. In this paper we identify and review studies in which the SDS was used as a treatment outcome measure. Our objectives are (i) to evaluate the sensitivity of the SDS to treatment effects and (ii) to examine potential thresholds or cutoff scores for remission and response. Studies for the review were retrieved from the National Library of Medicine's PubMed database (1966 to 21 March 2007) and other sources. All studies had to use the SDS, be double-blind, controlled or large open-label trials in English. Studies assessing nonpharmacological treatments, long-term trials (>12 weeks), small n trials (less than 20 patients per treatment arm) and trials for conditions other than one of the anxiety disorders, depression, or premenstrual dysphoric disorder were excluded. Extracted data included the diagnostic target of treatment, n, study design, and method of analysis. Initial, endpoint and/or mean change scores were extracted from tables, text, or extrapolated from figures. In all, 37 studies meeting the inclusion criteria were retrieved and reviewed. All of the studies treated the SDS as a numeric scale and analyzed mean change or endpoint differences with parametric statistics. Three provided additional outcome data using nonparametric response or remission criteria. Overall, the SDS performed well in discriminating between active and inactive treatments. The results indicate that the SDS is sensitive to treatment effects. To establish reliable and valid cutoff scores for remission and response, there is a need to supplement parametric analyses using mean change and endpoint differences with nonparametric analyses showing the percentage meeting specified response and remission criteria. In addition, the percentages with endpoint scores of zero should be reported.

Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale.

We had two aims in the revision of our corresponding chapter from the last handbook (Burlingame, MacKenzie, & Strauss, 2004): (1) provide the best evidence-based recommendations for using specific group approaches to treat specific patient populations; and (2) highlight factors other than the treatment model that may explain additional outcome variance. Today’s group treatments are guided by structured protocols that have been submitted to rigorous empirical scrutiny. The typical research study identifies a particular disorder and then articulates specific group interventions that are proposed to lead to desired effects (e.g., reduction in depression). Indeed, in our previous review we criticized some areas of the group literature for lack of clarity in the desired effects and the interventions intended to produce these effects (e.g., groups for the elderly). Consequently, the bulk of the current chapter summarizes evidence about specific group interventions that lead to specific effects for specific patient populations. However, it is clear that study authors continue to struggle with outcome variance that is not explained by specific group interventions based on a theoretical model. We believe insufficient attention is given to well-known and measurable group properties and processes, which account for some part of this unexplained treatment variance. There is a distinct difference in the group treatments reviewed in this chapter from those covered in past handbook chapters. Earlier group research was conducted by investigators who held group treatment as a major part of their professional identity. They were conversant with the group dynamic and process literature, built these properties into their protocols, and often tested them as mechanisms of change that were independent of the theoretical model guiding treatment. In contrast, most of the randomized clinical trials (RCTs) summarized in this chapter appear to be conducted by investigators who are specialists in either a particular psychiatric or medical disorder (e.g., depression) or theoretical orientation (cognitive-behavior therapy; CBT) with the research being an extension of one or both of these identities. Stated differently, being a group clinician or specialist in group dynamics does not seem to be a core part of the identity of the investigators producing recent group treatment research. The state of the current literature and our own appreciation of the group dynamic literature led us to a choice point: criticize nearly all RCTs for not explicitly incorporating group properties, or present a heuristic to assist future investigations. Our fundamental objective is to use empirical knowledge regarding group properties to increase the effectiveness of group treatments. Hence, we provide a general model of evidence-based group properties later in the chapter and select a few properties to illustrate their relationship to patient outcomes. We urge both researchers and clinicians to become familiar with this part of the evidence-based group literature. We end with a discussion of a small but growing movement that uses sound measures of these properties to assist the clinician to maximize outcome in group treatment: practice-based group treatment .

Change mechanisms and effectiveness of small group treatments

Climate change is not only affecting our environment, but also negatively impacting mental health globally. While physical health problems caused by climate change have been increasingly studied in medical literature, few studies have investigated mental health problems caused byclimate change. In order to bridge this gap in the literature and assess the psychological impact of climate change, it is crucial to create adequate psychometric tools such as the Climate Change Anxiety Scale (CCAS) developed by Susan Clayton. In this study, 150 Italian adults (67.4% females, and 32.6% males aged 19–76) were recruited online and required to complete CCAS, as well as GAD-7, K-10, NEP, PEBS, PESE/PSSE, and GSE in order to assess the psychometric properties of and validate CCAS in Italy. Patients were retested after three months. Data was collected from January to June 2021. The study used a 13-item version of the CCAS, which was based on the first two factors of Clayton's original scale. Researchers specifically analyzed internal consistency, test-retest reliability, and discriminant validity. Factor structure of CCAS was specifically addressed: a CFA was carried out to analyze the two-factor structure proposed in the original validation study. An EFA was then conducted and it was hypothesized that a single-factor structure could better fit data. Climate Change Anxiety Scale items exhibited reasonably good internal consistency. Test-retest reliability at a three-month evaluation proved to be good. The experience of climate change anxiety proved to be related to anxiety, pro-environmental behaviors, and low perception of self-efficacy.

Psychometric properties of the Italian version of the Climate Change Anxiety Scale

https://www.cidjournal.com/article/S0738-081X(98)00053-4/pdf

Cognitive-behavioral techniques.

Cognitive-behavioral therapy (CBT) is well documented in the treatment of panic disorder with or without agoraphobia; however, little is known about the efficacy of group treatment. The purpose of this open study is to investigate the benefits of a combination of the major cognitive and behavioral techniques used in the several specific versions of CBT thus far developed, in a psychotherapeutic group approach for panic and agoraphobia. Seventy-six outpatients meeting the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R; American Psychiatric Association, 1987) criteria for panic disorder with or without agoraphobia were included in the study. The treatment consisted of 14 weekly 2-hr group sessions and included: (a) an educational component, (b) interoceptive exposure, (c) cognitive restructuring, (d) problem solving, and (e) in vivo exposure. Patients achieved significant treatment gains on all dimensions assessed with a high rate of panic remission and significant improvement in the associated symptoms. Furthermore, these gains were maintained at 6-months’ follow-up. Our results suggest the feasibility of this combination of cognitive and behavioral techniques. The findings raise questions about the specificity and the impact of each technique. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 409–416, 2007.

Cognitive-BehavioralGroupTreatmentforPanic DisorderWithAgoraphobia

Cognitive-behavioral therapy (CBT) is well documented in the treatment of panic disorder with or without agoraphobia; however, little is known about the efficacy of group treatment. The purpose of this open study is to investigate the benefits of a combination of the major cognitive and behavioral techniques used in the several specific versions of CBT thus far developed, in a psychotherapeutic group approach for panic and agoraphobia. Seventy-six outpatients meeting the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R; American Psychiatric Association, 1987) criteria for panic disorder with or without agoraphobia were included in the study. The treatment consisted of 14 weekly 2-hr group sessions and included: (a) an educational component, (b) interoceptive exposure, (c) cognitive restructuring, (d) problem solving, and (e) in vivo exposure. Patients achieved significant treatment gains on all dimensions assessed with a high rate of panic remission and significant improvement in the associated symptoms. Furthermore, these gains were maintained at 6-months' follow-up. Our results suggest the feasibility of this combination of cognitive and behavioral techniques. The findings raise questions about the specificity and the impact of each technique.

/pdf/cognitive-behavioral-group-treatment-for-panic-disorder-with-2r55ygg4pw.pdf

Cognitive-behavioral group treatment for panic disorder with agoraphobia.

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Psychometric properties of the Italian version of the Climate Change Anxiety Scale

Cognitive-behavioral techniques.

Cognitive-BehavioralGroupTreatmentforPanic DisorderWithAgoraphobia

Cognitive-behavioral group treatment for panic disorder with agoraphobia.